Secretary of state offers opioid abuse solutions

Secretary of State Dennis Richardson said this week the state’s Prescription Drug Monitoring Program is constrained by state laws, preventing officials from fully addressing the epidemic.

The Prescription Drug Monitoring Program (PDMP) collects information on opioid and other controlled substance prescriptions from pharmacies to provide healthcare professionals with a patient’s prescription history. PDMPs also allow the tracking of physician prescribing practices to help state authorities create informed guidelines and address other efforts to improve addiction prevention and treatment.

An audit of the system was released Wednesday.

“Restrictions are placed on what data are collected, analyses that can be done with the data, and with whom information can be shared,” Richardson announced Wednesday. “Correcting (these) will maximize its potential and help address opioid and other substance abuse issues the state faces.”

The problem

When it comes to providing access to treatment and recovery support for those with substance use disorders, Oregon ranks last for adults and second-to-last for adolescents, the audit reads.

In Oregon, 4,270 people were recently prescribed a dangerous combination of opioids, benzodiazepines and muscle relaxants in the same month, which can be lethal if taken together. One Oregonian received a 1,545-day supply of zolpidem — sometimes used as a date-rape drug — from five different prescribers in one year.

“Shockingly,” Richardson said, “148 Oregonians received controlled substance prescriptions from 30 or more separate prescribers and filled their prescriptions at 15 or more pharmacies within a three-year time frame.

“Oregon has made some progress in dispensing fewer opioid prescriptions over recent years,” he added, “but our state still prescribes opioids at a rate of 13 percent more than the national average, and the U.S. prescribes more than other comparable countries.”

It’s a problem that permeates from the big cities into rural communities, including in Curry County, where there is a high population of veterans and senior citizens who legitimately use such medications.

Oregon has the highest rate in the nation of seniors hospitalized for opioid-related issues such as overdose, abuse and dependence, the audit reads. The median cost for each hospitalization due to opioids is $13,000. In 2016, almost 500 pregnancies were complicated by maternal opioid use, and 280 infants were born with Neonatal Abstinence Syndrome. From 2015 to 2017, 314 more children entered foster care due to a parent’s drug abuse. The state also has the sixth-highest percentage of teenage drug users. Many who are severely addicted also find themselves behind bars at some point.

“Many opioid deaths are preventable, but OHA is trying to fight this crisis with one hand tied behind its back,” Richardson said. “Oregon should learn from the experiences of other states and follow the best practices being successfully implemented across the nation.”

It’s complicated ...

Richardson said the Oregon Health Authority could better use PDMP data to analyze trends in prescribed drugs, but state laws prevent the agency from sharing information on questionable activity with key stakeholders, such as health licensing boards and law enforcement.

“We found people who received opioid prescriptions from excessive numbers of prescribers, as well as instances of dangerous drug combinations and prescriptions for excessive drug dosages,” he said. “One person who received an excessive amount of opioid prescriptions had some of those prescriptions paid for by Medicaid.”

The audit noted that Oregon is one of nine states that does not require prescribers or pharmacies to refer to the PDMP database before they write a prescription for or dispense an opioid to make sure someone is not trying to fill multiple opioid prescriptions.

Due to statutory restrictions, Oregon’s PDMP does not collect some prescription information that could be critical in preventing prescription drug abuse. This includes prescriptions filled by pharmacies other than retail: veterinarians, prescriptions for Schedule V drugs and drugs known to be abused or misused such as gabapentin.

Oregon’s PDMP collects less information from pharmacies and physicians when compared to other states, Richardson said, therefore making the program less effective.

“Auditors found numerous instances of ‘doctor shopping’ for opioids, dangerous drug combinations and prescriptions for excessive amounts of drugs. Currently, OHA cannot share this data with health licensing boards or law enforcement. The program is also prohibited from collecting information regarding Schedule V medications and methods of payment, which could be useful in preventing prescription drug abuse.”

Clearing hurdles

Auditors made 12 recommendations to the OHA, including requiring drug prescribers to register and use the PDMP, share data with the state’s Medicaid program, provide guidance on integrating use of the PDMP database and identify and propose drugs of concern.

Other recommendations include ensuring prescription information is complete, working with the legislature to expand laws to allow for more data analyses and sharing and collecting more information.

Some of these can be implemented within existing statutes, Richardson said, but others will require legislative changes. Seven of the 12 recommendations fall outside the scope of the OHA, limiting its ability to implement them.

“PDMP data shows questionable activity has been occurring for years,” the audit reads, “but state laws limit OHA’s ability to investigate and mitigate such activity.”

Other suggested changes include:

•Provide guidance to prescribers on how to use the PDMP database in their daily workflow,

• Verify practitioner specialty information with the health licensing board and update the PDMP database with this information,

• Develop a process for sharing data between the PDMP and Medicaid to allow Medicaid to better monitor the prescription behavior of its clients,

• Identify drugs of concern that should be added to the state’s controlled substance list and add them to the PDMP.

• The audit recommends the legislature address the issue of prescribers not registering with the PDMP and pharmacies not submitting corrected data and

• It suggests further authority be granted to the Clinical Review Subcommittee to allow licensing boards and law enforcement to collaborate on issues of common concern and to other professional and state entities to access PDMP information.